THE ARAB BOARD-FOR HEALTH SPECZALIZA TIONS

THE SCIENTIFTC COUNCIL

OF SURGERY

FINAL WRITTEN EXAMINATION

GENERAL SURGERY
OCTOBER /29 /2018
SECO~D P~ZR
12.30 - 3.00 P.M

NAME ....................................................................................
EXAM NO. ....................................................................................
EXAMCENTER ....................................................................................

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 GENERAL SURGERY
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DIRECTION

QUESTIONS l - 100

EACH QUESTION OR INCOMPLETE STATEMENT IS FOLLOWED

BY FIVE SUGGESTED RESPONSES OR COMPLETIONS.
SELECT THE ONE BEST RESPONSE FOR EACH QUESTION AND FILL IN
THE CORRECT CORRESPONDING LETTER ON THE ANSWER SHEET.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

P l ~ ~ Written-Gen.
al Sure.

'
1. An 85-year-old nursing home patient is found to have a worsening stage 111
sacral pressure ulcer. The ulcer is debrided and tissue for culture obtained.
Tissue cultures reveal 10' organisms per gram of tissue after operative
debridement. What is the next most appropriate step in management of the
patient's wound?

A. Muscle flap coverage

B. Wound vacuum-assisted closure (VAC)
C. Intravenous antibiotics
D. Repeat debridement
E. Debridement with immediate application of a split-thickness skin graft

2. Which of the following statements regarding MRSA is TRUE?

A. The treatment of choice is clindamycin

B. MRSA can only be found in the health care setting.
C. MRSA is more virulent than methicillin sensitive S. aureus
D. Treatment of surgical patients with intranasal mupirocin decreases wound
infection rates with MRSA
E. Hospitalized patients colonized with MRSA require contact isolation

3. A surgical resident is stuck with an HCV-contaminated hollow-bore needle.

Which of the following tests should be done initially?

A. Detection of HCV RNA

B. Detection of HCV surface antigen
C. Detection of HCV antibodies by enzyme irnmunoassay
D. Measurement of viral load
E. Detection of HCV core antigen

4. Which of the following statements is TRUE regarding beta-haemolytic

streptococci?

A. They produce a characteristic beta-lactamase.

B. They are one of the causes of necrotizing fasciitis
C. They are the most common cause of infective endocarditis.
D. They are resistant to ampicillins.
E. They are part of the normal vaginal flora

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

'.
- Final Written-Gen. Surg.

5. The phrenic nerve :

A. Runs from lateral to medial, over the scalenus anterior muscle, deep to the
transverse cervical vessels.
B. Runs from medial to lateral, over the scalenus anterior muscle, deep to the
transverse cervical vessels.
C. Runs from medial to lateral, over the scalenus anterior muscle, superficial to the
transverse cervical vessels.
D. Runs from lateral to medial, over the scalenus anterior muscle, and his a variable
relationship with the transverse cervical vessels
E. Gives only motor supply of the diaphragm.

6. During the course of a neck dissection, the surgeon inadvertently punctures the
lower end of the internal jugular vein, causing profuse bleeding. The most
appropriate immediate management is to:

A. Raise the head of the bed, identify the tear, and repair it with polypropylene
sutures (5-0 Prolene).
B. Raise the head of the bed, identify the tear, and repair it with a patch graft from a
saphenous vein.
C. Lower the head of the bed, use two suctions, identify the tear, and repair it with
polypropylene sutures.
D. Pack the lower part of the wound with moist gauze and request a thoracic surgery
consultation, leaving the pack in place until a partial upper sternotorni is
performed
E. Pack the wound and follow up later.

7. Which of the following salivary cancers arising in the parotid gland is most likely
to metastasize to cervical nodes?

A. Adenoid cystic carcinoma

B. Low-grade mucoepidermoid carcinoma
C. ~~ithelial-myoebithelialcarcinoma
D. Carcinoma ex pleornorphic adenoma
E. Acinic cell carcinoma

8. The surgical demarcation between level I11 and level IV in the neck is:

A. The upper border of the omohyoid muscle.

B. The lower border of the omohyoid muscle
C. A horizontal line along the inferior border of the cricoid cartilage.
D. The transverse cervical vessels
E. Hyoid bone

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 Final Written-Gen. Surg.
S .

9. Custatory sweating after parotidectomy is caused by :

A. Stimulation of sweat glands by parasyrnpathetic fibers from the auriculotem~oral

branch of the trigeminal nerve.
B- Stimulation of sweat glands by sympathetic fibers from the auriculotemporal
branch of the trigeminal nerve.
C. Stimulation of sweat glands by postganglionic fibers via the glossopharyngeal
nerve.
D. Stimulation of sweat glands originating in the superior salivatory ganglion.
E. Zygomatic branch of facial nerve

10.The most reliable landmark for the facial nerve is the:

A. Tragal pointer.
B. Posterior belly of the digastric.
C. Tympanomastoid suture line.
D. Bony cartilaginous ear canal.
E. Mastoid process

11.Which of the following statements about the deep lobe of the parotid is
CORRECR

A. Most tumors within the deep lobe are benign.

B. Most tumors within the deep lobe are malignant.
C. Most tumors within the deep lobe are sarcomas.
D. Most tumors within the deep lobe are neurofibromas
E. Most tumors within the deep lobe are lymphomas

12.The principal blood supply to the parathyroid glands is which of the following?

A. Sugerior thyroid arteries

B. Inferior thyroid arteries
C. Thyroidea ima arteries
D. Parathyroid arterial branches directly from the external carotid artery
E. Highly variable

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Surg.

13. Which of the following statements about maxillofacial trauma is FALSE?

A. Asphyxia due to upper airway obstruction is the major cause of death From facial
injuries.
B. The mandible is the most common site of facial fkacture.
C. k e Le Fort I1 fracture includes a horizontal fracture of the maxilla along with
nasal bone fracture.
D. Loss of upward gaze may indicate either an orbital floor or orbital roof fracture
E. Mandibular fractures can be fixed with plate and screws

14. A ranula is a:

A. Lipoma.
B. Mucocele.
C. Granuloma.
D. Minor salivary gland.
E. Adenoma

15. Dermatofibrosarcoma protuberads :

A. Is a tumor of the thyroid cartilage.

B. Is a tumor of the larynx.
C. Is a tumor of the salivary glands.
D. I's a tumor of the skin
E. Is a high grade malignant tumor

16. A cavernous hemangioma :

A. Is also known as a strawberry news and regresses with time.

B. Fails to regress with time.
C. May be treated with OK-432.
D. May dedifferentiate to hemangiopericytoma
E. Occurs mostly in the upper limb

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Wrltten-Gen. Surg.

17-A 60-year-old alcoholic is admitted to the hospital with a diagnosis of acute' '
pancreatitis. Upon admission, his white blood cell (WBC) count is 21,000. His
lipase is 500, blood glucose is 180 mg/dL, lactate dehydrogenase (LDH) is 400
IUfL, and aspartate aminotransferase (AST) is 240 IUIdL. Which of the
following is TRUE?

A. This patient is expected to have a mortality rate of less than 5%.

B. The patient's lipase level is an important indication of prognosis.
C. This patient requires immediate surgery.
D. A venous blood gas would be helpful in assessing the severity of illness in this
patient.
E. A serum calcium level of 6.5 mg/dL on the second hospital day is a bad prognostic
sign.

18. A 35-year-old woman presents with episodes of obtundation, somnolence, and

tachycardia. An insulinoma is suspected based on a random serum glucose test
value of 38 mg. per dl. Which of the following statements is TRUE?

A. The most important diagnostic study for insulinoma is an oral glucose tolerance
test.
B. It may be helpful to perform ERCP in ah effort to localize the tumor.
C. Most patients with insulinoma present with extensive disease, rendering them only
rarely resectable or curable.
D. The diagnosis is best confirmed by elevated C-peptide or proinsulin levels and
screening for anti-insulin antibodies.
E. Is mostly found in the head of pancreas

19. Which of the following statements regarding unusual hernias is INCORRECF

A. An,obturator hernia may produce nerve compression diagnosed by a positive

Howship-Romberg sign.
B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's
hemia occurs through the inferior lumbar triangle.
C. Sciatic hernias usually present with a painful groin mass below the inguinal
ligament.
D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole
component of the hernia sac.
E. Richter's hernia involves the antimesenteric surface of the intestine within the
hemia sac and may present with partial intestinal obstruction.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

..

. Final Written-Gen. Surg.

20. The most common site of adenocarcinoma of the small intestine is the:

A. Duodenum.
B. Jejunum.
C. Ileum.
D. Equal incidence
E. Duodenojejunal junction

21. The most common benign tumor of the small intestine is:

A. Adenoma.
B. Hemangioma.
C. Leiomyoma.
D. Endometrioma
E. Lipoma

22.A 20-year-old unrestrained driver was involved in a motor-vehicle crash. A

computed tomography (CT) of the abdomen revealed a large hematoma in the
second portion of duodenum. The rest of the abdomen is normal. The initial
management of this duodenal hematoma should be:

A. Operative evacuation
B. Nasogastric decompression, intravenous fluids, and gradual resumption of oral
diet
C. Endoscopic retrograde cholangiopancreatogram(ERCP)
D. Laparotomy, pyloric exclusion, and gastrojejunostomy
E. Octreotide

23.111 a patient who had a motor-cycle crash, a CT of the abdomen revealed a

peripancreatic hematoma and indistinct pancreatic border. The most defiaitive
test for a pancreatic injury requiring operative intervention is:

A. ERCP
B. Ultrasonography
C. CT scanning
D. Operative exploration
E. Amylase test of lavage fluid .

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Flnnl Wrltten-Gen. Surg.

24.A 50-year-old man develops acute pancreatitis due to alcohol abuse..

Hyperarnylasemia resolves by the third day after admission. By the eighth
hospital day, the patient is noted to have recurrent fever (38.S°C), progressive
leukocytosis (18,500 WBC/mm3), and tachypnea. The most appropriate
management incluoes which as the next step?

A. Laparotomy with pancreatic debridement

B. CT guided aspiration of peripancreatic fluid collections
C. ERCP with sphincterotomy and placement of biliary stent
D. Intravenous amphotericin B
E. Nasogastric suction and somatostatin

25. The following statement about peritonitis are all true EXCEPT:

A. Peritonitis is defined as inflammation of the peritoneum.

B. Most surgical peritonitis is secondary to bacterial contamination.
C. Primary peritonitis has no documented source of contamination and is more
common in adults than in children and in men than in women.
D. Tuberculous peritonitis can present with or without ascites.
E. Most cases of secondary peritonitis need surgical interference

26. Retroperitoneal fibrosis is a fibrosing condition of retroperitoneurn, which is of

significance as it generally encompasses the ureters and eventually causes
hydronephrosis and kidney damage. Which of the following statements is FALSE
concerning this condition?

A.The majority of cases are idiopathic in nature

B. A history of use of methysergide for treatment of migraine headaches would be
significant
C.There is known association of malignancy with retroperitoneal fibrosis
D.The disease occurs more commonly in women than in men
E. Medialisation of ureters is the surgical procedure of choice

27.111 "catabolic" surgical patients, which of the following changes in body

composition does not occur?

A. Lean body mass increases.

B. Total body water increases.
C. Adipose tissue decreases.
D. Body weight decreases.
E. Muscle protein decreases

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

- Final Written-Gen. Surg.

28. Which of the following statements is FALSE of the multiple organ dysfunction
syndrome (MODS)?

A. The "two-hit" model proposes that secondary MODS may be produced when even
a relatively minor second insult reactivates, in a more amplified form, the systemic
inflammatory response that was primed by an initial insult to the host.
B. t h e systemic inflammatory response syndrome (SIRS), shock due to ~ e p s i ors
SIRS, and MODS may be regarded as a continuum of illness severity.
C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a
critical factor in the sustained, uncontrolled release of inflammatory rpediators.
D. The incidence of MODS in intensive care units has decreased owing to increased
awareness, prevention, and treatment of the syndrome.
E. MODS carry a very high mortality

29. Which of the following statements about the role of the gut in shock and sepsis is
FALSE?

A. Selective decontamination of the digestive tract with the use of oral antibiotics has
been shown to reduce nosocomial pneumonias and to improve mortality rates.
B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus
architecture of the gut.
C. Gut dysfunction may be an effect of shock, but it may also contribute to the
development of MODS by the mechanism of bacterial translocation.
D. As compared with parenteral nutrition, enteral nutrition is associated with a
reduction in septic morbidity.
E. Ischemic changes in gut increases the chance of translocation of bacteria

30. A 32-yearsld female falls from the tenth floor of her apartment building in a n
apparent suicide attempt. Upon presentation, the patient has obvious head a n d
extremity injuries. Primary survey reveals that the patient is totally apneic. By
which method is the immediate need for a definitive airway in this patient BEST
provided?
-
A. Orotracheal intubation
B. Nasotracheal intubation
C. Percutaneous cricothyroidotomy
D. Intubation over a bronchoscope
E. Needle cricothyroidotomy

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Surg.

31. Which of the following measures is not effective in preventing stress gastritis'
bleeding in critically ill patients?

A. Improving systemic circulation by correcting any shock like state resulting from
blood loss or sepsis.
B. Correcting systemic acid-base abnormality.
C. Parenteral nutrition.
D. Reducing intragastric acidity by either antacid titration or H 2 antagonists.
E. Use of PP1

32. Addisonian crisis, or acute adrenocortical insufficiency:

A. Occurs only in patients with known adrenal insufficiency or in those receiving

long-term supraphysiologic doses of exogenous steroids.
B. Can mimic an acute abdomen with fever, nausea and vomiting, abdominal pain,
and hypotension.
C. May cause electrolyte abnormalities, including hypernatremia, hypokalemia,
hypoglycemia, and hypercalcemia, as well as eosinophilia on peripheral blood
smear.
D. Should be diagnosed with the rapid ACTH stimulation test before steroid
replacement is instituted.
E. May be effectively treated with intravenous stress-dosel glucocorticoid and
mineralocorticoid replacement.

33. Glucose overload results in increased CO2 production. Which of the following
statements is TRUE?

A. In patients with respiratory insufficiency, administration of glucose as a principal

cal~riesource is contraindicated.
B. In patients with pulmonary infection and sepsis, calorie support should consist of
95% fat and 5% glucose.
C. Increased CO 2 production and difficulty in weaning was associated only with
pronounced overfeeding.
D. COz production should be measured in most patients who are supported by
respirators in intensive care units and are receiving nutritional support.
E. Measurement of respiratory quotient is of no value in patients on prolonged TPN

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Surg.

34. With regard to the right internal jugular vein, which of the following is FALSE?

A. Is cannulated at the level of the thyroid cartilage

B. Has the right common carotid artery medial to it
C. Is approached anterior to the sternocleidomastoid muscle
D. Is commonly used by anesthetists for central lines
E. When cannulated in low approach, damages the pleura

35. Regarding electrolyte administration in the adult the following are true
EXCEPT:

A. Infbsion of potassium should not normally exceed 40rnmoVh.

B. Daily sodium requirement is l-2mmoVkg.
C. Most calcium in the extracellular fluid is protein-bound.
D. One gram of magnesium sulphate contains 4mmol magnesium.
E. The normal range for phosphate in the plasma is 0.8-1 .5mmoVL (2.5-4.6mg/d~):

36.The most common pericardial tumor is:

A. Teratoma.
B. Lymphoma.
C. Mesothelioma.
D. Hemangioma.
E. Metastatic bronchogenic carcinoma.

37. Adequate flow during cardiopulmonary bypass is BEST indicated by: .

A. Systemic blood pressure of 90150 mmHg

B. Arterial P02 of 230 mmHg
C. Mixed venous hemoglobin saturation of 78%
D. Central venous pressure of 1 mmHg
E. Plasma lactate value of 6 mg/dl

38.111 an adult with severe aortic valve stenosis the most determining factor in
determining the timing of aortic valve replacement is: .

A. Measured valve area of less than 0.8 cm2

B. Mean transvalvular gradient of greater than 50 mmHg
C. The presence of risk factors for coronary artery disease
D. Presence of significant left ventricular hypertrophy on echocardiographic
examination
E. Presence of symptoms.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Flnrl Wrlitar-Gea. Suq.

39. In Pulmonary contusion, one of the following is CORRECT:

A. Commonly causes immediate respiratory Mculties.

B. Results in increased lung compliance at 24 hours.
C. It is the most cokrnon type of lung injury in penetrating chest trauma
D. Usually causes ventilation/perfision mismatch which evolves over 24 hours.
E. Lung contusion is an entity involving injury to the alveolar capillaries, due to
major tear in lung tissue.

40. The most common cause of pure aortic stenosis is:

A. Rheumatic fever
B. Bicuspid aortic valve
C. Bacterial endocarditis
D. Syphilis
E. Marfan's syndrome

4l.Which of the following is the most common mode of presentation of cardiac

myxomas?

A. Cardiac rhythm disturbances

B. Congestive heart failure
C. Embolization
D. Fever
E. Myalgia

42.The classical indication for surgical treatment of focal nodular hyperplasia

(liver) is:

A. Malignant degeneration
B. Risk of rupture
C. Symptomatic lesion
D. Risk of hemorrhage
E. Risk of infection

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Surg.

43.A 45-year-old patient is one week following an attack of severe acute

pancreatitis. He has been unable to start eating as this precipitates severe pain.
. Physical examination reveals a soft abdomen with epigastric tenderness. Bowel
sounds are scanty. He is afebrile. His amylase in normal and C-reactive protein
is elevated. Which of the following statements regarding management of
nutrition is CORRECT?

A. NO supplementary nutrition is required

B. Total parenteral nutrition should be commenced
C. Nasogastric feeding should be commenced
D. Nasojejunal feeding should be commenced
E. Feeding through PEG tube

44.During liver surgery, Pringle rnaneuver was required, all of the following
structures are involved in this maneuver EXCEPT:

A. Hepatic artery
B. Common bile duct
C. Portal vein
D. Hepatoduodenal ligament
E. Inferior vena cava

45. Which of the following statements regarding splenic anatomy is TRUE?

A. The spleno-colic ligament is vascular.

B. The splenic artery has a straight course unlike the vein.
C. The normal weight of the spleen is up to 250 g.
D. The inferior mesenteric vein joins the splenic vein.
E. The spleen lies alongside left 11" andl2" ribs.

46. Insulinorna is characterized by all of the followings EXCEPT:

A. Of pancreatic origin in 99%

B. Solitary in 90%.
C. Size in 90% is more than 3cm.
D. Benign in 90% of cases.
E. Associated with multiple endocrine neoplasia in 8%.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Flnal Wrltten-Gen. Surg.

47.0ne of the following would exclude a. patient with HCC from becoming a '

transplant candidate:

A. A single l-cm lesion in the liver with microvascular invasion.

B. Two lesions each less than 2 cm.
C. A solitary l-cm HCC metastatic lesion in the lung .
D. A single 4.8-cm HCC lesion in segment VIII.
E. Portal vein thrombus.

48. With regard to gall bladder stones (CBS), which of the following statements is
TRUE?

A. Pure cholesterol stones are usually multiple

B. Black pigmented stones occur mostly in the biliary tree
C. The main component of brown pigmented stones is calcium palmitate
D. Brown pigmented stones are associated with hemolysis
E. Risk of gallbladder adenocarcinoma is more with small tiny stones than large
stones

49.The BEST treatment option for perforated duodenal ulcer secondary to chronic
use of non-steroidal anti-inflammatory drugs (NSAID) is:

A. Highly selective vagotomy

B. Truncal vagotomy with pyloroplasty
C. Simple closure with Graham patch
D. Truncal vagotomy with gastrojejunostomy
E. Antrectomy
5O.What is the most commonly associated risk factor for pancreatic
adenocarcinoma?

A. smbking
B. Chronic pancreatitis
C. Diabetes mellitus
D. Obesity
E. Lynch syndrome

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Surg.

51. Which one of the following types of cholecystitis may mimic gallbladder
adenocarcinoma?

A. Emphysematous cholecystitis
B. Xanthogranulomatous cholecystitis
C. Acute calculous cholecystitis
D. Acute acalculous cholecystitis
E. Chronic cholecystitis

52.The commonest complication of a liver hydatid cyst is:

A. Biliary communication.
B. Free rupture to the peritonea1 cavity.
C. Cyst infection.
D. Compression of the hepatic veins.
E. Fistulization to a hollow viscus.

53. One is TRUE in regarding trauma of the spleen:

A. This organ is rarely involved in blunt trauma.

B. Splenic preservation should be the rule when there are associated significant
injuries.
C. Vaccine should be given 1-2 weeks after splenectomy.
D. Overwhelming postsplenectomy sepsis (OPSS) is more than 10%.
E. Non-operative management is limited to grades 1&2.

54.A 23- year old man sustained bilateral femoral fractures and ad open tibia
fracture in a motorcycle accident. Before proceeding with surgery, What is tile
BEST measure of the patient's resuscitation?
A. Systolic blood pressure
B. Mean arterial pressure
C. Urine output
D. Base deficit
E. Heart rate.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 Final Written-Gen. Surg.

55.The tl~crapcuticrationale for parly ( within 24 hours) stabilization of femoral ' ,

shaft fractures for multiple trauma patients is to decrease:-

A. Rate of non -union

B. Pulmonary complications
C. Incidence of infection
D. Required analgesics
E. Rate of transfusion

56. In early assessment and resuscitation of a trauma patient which of the following
is FALSE:

A. A tourniquet is applied in life threatening bleeding when digital pressure fails

B. Airway patency should be maintained with control of cervical spine
C. A urinary catheter should be inserted in unconscious patients
D. A normal cervical spine lateral view x-ray excludes cervical spine injury
E. Endotracheal intubation should be done in apneic patients

57. All true about compartment syndrome EXCEPT:

A. Neural tissues demonstrate hnctional abnormalities (parasthesia and

hyperesthesia) within 30 min of the onset of ischaemia
B. Irreversible nerve functional loss after 12h
C. Irreversible muscular changes beginning from 8-12h
D. Ischaemia of 4 h gives rise to significant myoglobinuria
E. Compartment syndromes lasting longer than 12h produce chronic functional
deficits.

58.All the following are important clinical features to diagnose compartment

- syndromeEXCEPT:

A. Pain out of proportion to the stimulus

B. Pain on passive stretch of the affected muscle compartment
C. Altered sensation
D. Loss of pulse
E. Tenderness over the muscle compartment.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

. Final Written-Gen. Surg.

59. If a patient sustains trauma of all his fingers of one hand, then the sequence of
attempted replantation would be in the following order:

A. Thumb, index, middle, ring, small

B. Thumb, middle, ring, small ,index
C. Thumb, middle, ring, index. Small
D. Index, thumb, middle, ring ,small
E. Index, thumb, ring , small, middle

60.A 43-year-old man is admitted following an RTA, he is found in respiratory

distress, he is intubated and ambubag ventilated, the anesthetist tells you that he
exercises a lot of pressure to ventilate the patient, there is reduced,air entry to
the left side of the chest and the trachea is shifted to the right side. Which of the
following is'tbe most appropriate management option in this patient?

A. A chest X-ray.
B. A CT thorax.
C. Needle decompression of the left side of the chest.
D. Insert a chest drain.
E. Mechanical ventilation with PEEP.

61. All of the following types of shock are distributive EXCEPT:

A. Septic shock
B. Hemorrhagic shock
C. Addisonian shock
D. ~eurogenicshock
E. Anaphylaxis

62.A child who was involved in a road traffic accident has a bleeding,open femur
fracture. What is the first step in fluid resuscitation in the emergency room?

A. Bolus 10mVkg of normal saline

B. Bolus 20mVkg of normal saline
C. Bolus 20mVkg of colloid
D. Transfuse 20mllkg of packed red blood cells
E. Transfuse 2Omlkg of packed red blood cells, fresh frozen plasma, and platelets

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Written-Gen. Sure.

63. Regarding pneumothorax all are true EXCEPT:

A. Closed pneumothorax is relatively common and may not be clinically significant

B. In tension pneumothorax air can only escape via the bronchial tree
C. In tension pneumothorax there may be tracheal deviation towards the contralateral
lung
D. There may be an increase of 40 mmHg in intrapleural pressure on the affected side
E. Tension ineumothorax is usually diagnosed by C X R

64. Rejection that starts on the postoperative day two is most likely:

A. Hyperacute
B. Accelerated
C. Acute
D. Subacute
E. Chronic

65. For a 70 kg man, the minimum acceptable urine output is:

A. 7 m11 hour.
B. 70 m11 hour.
C. 35 mV hour.
D. 100 mV hour.
E. 105 m11 hour.

66. Which one of the following organs or tissues is considered to be the most
immupogenic following allograft transplantation?

A. Kidney.
B. Heart.
C. ~kih.
D. Pancreas.
E. Lung

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 '.
. Final Written-Gen. Surg.

67.A 46-year-old woman has a palpable neck mass. Fine-needle aspiration (FNA)
reveals papillary cells. At neck exploration, she has a 4-cm tall cell variant
papillary cancer with no lymphatic invasion but lymphocytic thyroiditis. Total
thyroidectomy is performed. .Which of the following gives her a more
unfavorable prognosis?

A. Sex
B. Age
C. Primary tumor size
D. Tall cell variant
E. Lymphocytic thyroiditis

68. A 35-year-old woman entering her second trimester of pregnancy is hypertensive

and has elevated 24-hour urine catecholamines. A previous pregnancy ended
with spontaneous abortion a t the end the second trimester. Which of the
following statements is TRUE?

A. She has pre-eclampsia and needs medical management

B. She is a candidate for alpha blockade and adrenalectomy at this time
C. She should be managed to term with alpha blockade and planned vaginal delivery
D. Alpha blockade has an increased complication rate with earlier gestational age
E. The best diagnostic imaging study during pregnancy is a metaiodobenzylguanidine
(MIBG) scan( or CT scan)

69.A 34-year-old man who is a member of a known multiple endocrine neoplasia 1

(MEN1) presents with a 2-cm lesion in the head of his pancreas and elevated
gastrin levels. Which of the following statements is TRUE?

A. 24-hour urine catecholamine levels should be assessed prior to operation

B. At operation a thorough examination of the duodenum is essential
C. The presence of multiple small hepatic metastases at operation dictateh a palliative
procedure
D. If no other disease is seen at operation, resection of the mass would be associated
with a recurrence rate of 5% and excellent survival
E. Themost common functioning pancreatic lesion in MEN1 is an insulinoma

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 Final Written-Gen. Surg.
, .,
S.

70. A 60-year-old man has a 4-cm Jeft thyroid nodule. Fine-needle aspiration (FNA)
of the nodule is interpreted as papillary cancer. No lymph nodes a r e palpalple.
Management of this patient should include all of the following EXCEPT

A. Total thyroidectomy
B. Radioactive iodine ablation
C. Suppressive thyroxine
D. Modified left radical neck dissection
E. S e h m thyroglobulin monitoring

71. A 42-year-old woman is a known member of a multiple endocrine neoplasia type

2A (MEN 2A) kindred. She and her mother have both had total thyroidectomy
for medullary carcinoma of the thyroid (MCT). She would like her '6-year-old
daughter to be tested for possible MCT. The child's physical examination is
normal. Which of the following should be done?

A. Serum calcitonin and carcinoembryonic antigen (CEA) deterrninations

B. Basal and stimulated serum calcitonin levels
C. Iodine 131 radionuclide scan
D. Annual physical examinations; fine-needle aspiration if a thyroid mass is
appreciated, or an ultrasound study at age 12
E. RET oncogene determination

72.Which of the following is characterized by gallstones, diabetes, and steatorrhea?

A. Glucagonoma
B. InSulinoma
C. Vipoma
D. Gastrinoma
E. Somatostatinoma

73.Which of the followings has the BEST localization accuracy to delineate small
extra adrenal pheochromocytoma ?

A. CT abdomen
B. MRI abdomen
C. UIS abdomen
D. Positron emission tomography
E. Meta-Iodo- ~ e n z ) l - ~ u a n i d i n(MIBG)
e scan

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

'. Final Wrlttcn-Gen. Surg.

74. Which of the following is NLT correct regarding .management of thyroid

carcinoma?

A. Total thyroidectomy if diagnosis is made pre or intraoperatively

B. Completion thyroidectomy is indicated in follicular carcinoma to allow the use of
radioactive iodine
C. Surgery for medullary carcinoma in MEN 11 should precede management of other
endocrine gland tumors
D. Involved lymph node metastases should be dealt with surgically
E. In anaplastic carcinoma tracheostomy is indicated as a treatment for respiratory
obstruction only

75.Which of the following is the most important indication for drainage of

pancreatic pseudocyst:

A. Pseudocyst related symptoms.

B. Pseudocyst size.
C. Pseudocyst duration.
D. Pseudocyst associated with chronic pancreatitis.
E. 'fseudocyst larger than 5 cm and present for longer than 6 weeks.

76.All the following are absolute condraindication to laparoscopic inguinal

hernia repair EXCEPT:

A. Presence of infection
B. Previous radical prostatectomy
C. Strangulated hernia.
D. Liver cirrhosis with portal hypertension
E. History of pelvic irradiation

77.In which of the following conditions is the Enteral route appropriate for,
nutrition? ,

A. Upper gastrointestinal bleed.

B. Complete small bowel obstruction.
C. Acute flare up of crohn's disease.
D. Low output colonic fistula.
E. High output small bowel fistula .

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 Final Written-Gen. Surg.

78. Laparoscopic appendectomy iq children:

A. As expertise increased, the operative time is equal to that of open

B. Hospital stay is shorter than that of open
C. The cost of the procedure is comparable to that of open
D. Resumption of normal activity is same as that of open
E. Pneumoperitoneum using veres needle had similar complications to other
Laparoscopic procedures

79. Which of the following TPN complication is not related to intralipid component?

A. ~~*erli~idemia
B. Thrombophlebitis
C. Alteration of pulmonary finction
D. Coagulation abnormalities
E. Cholestasis and liver damage

80. Regarding enteral tube feeding, all of the following statements are true EXCEPT:

A. Continuous feeding is better than bolus.

B. Gastrostomy feeding is better than jujenostomy.
C. Initially hypotonic fluid is recommended.
D. Elemental diet is advised in enzymatic deficiencies.
E. Is considered as an alternative to parenteral nutrition.

81.A 91-year-old man presents with small bowel obstruction. Gallstone ileus is
suspected. After resuscitation, the BEST treatment approach would be

A. Conservative management with nasogastric suction

- B. ~ a ~ a r o t oand
m ~milking of the stone into the large bowel
C. Cholecystectomy, repair of the small bowel component of the fistula, common bile
duct exploration, and extraction of the stone through an enterotomy
D. Removal of the stone through a proximal enterotomy
E. Colonoscopic disruption and extraction of the stone

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

*
-
. Final Written-Gen. Sure.
1

82. Which of the following statements about recurrent rectal prolapse is FALSE?

A. Rectopexy with nonabsorbable mesh is more effective than suture rectopexy

B. Recurrence after suture rectopexy is approximately 5% at 5 years
C. The perinea1 approach for fill-thickness rectal prolapse should be reserved for
patients who are not candidates for the transabdominal approach
D. Recurrence rates are higher after operation for recurrent rectal prolapse compared
with primary rectal prolapse
E. Repeat rectosigmoidectomy may be performed for recurrent prolapse

83.Three weeks after elective sigmoid resection for cancer, a 70-yearbld man has
Clostridium diflicile colitis. After a 5-day course of metronidazole, he has
profuse diarrhea and a heart rate of 130lmin. Urine output has been decreasing
over the last 3 hours. Management has included fluid resusbitation and
sigmoidoscopy, and a stool sample has been sent for C difficile toxin assay and
culture. Sigmoidoscopy showed no pseudomembranes. The computed
tomographic (CT) scan shows no intraperitoneal collection.
Which of the following statements is TRUE?

A. This patient has no criteria consistent with a diagnosis of filminant C difficile

colitis
B. Fulminant C difficile colitis is commonly associated with leukopenia
C. A history of C difficile confers immunity for recurrent infection with C difficile
D. Toxin assay may be negative in > 10% of patients with fulminant C dificile colitis
E. Medical and surgical therapy for filminant C difficile colitis are associated with
similar mortality rates

84. Thesmall bowel tumor with the greatest propensity for bleeding is :

A. Carcinoid
B. Lymphoma
C. Adenocarcinoma
D. Hamartoma
E. Gastrointestinal stromal tumor (GIST)

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

 Final Written-Gen. Surg. PII- Oct.2048
I

*
85.While performing. a small b w e l resection for strictures following crohnWs '
disease, you realize that on inspection, there are marked differences between
jejunal and ileal anatomy. Such differences include all the following EXCEPT:

A. Wider lumen in the jejunum.

B. Less lymphatics in the jejunal mesentery compared to ileal. .
C. More prominent and multiple arcades of vessels in the ileum.
D. Thicker wall of the jejunum.
E. Thicker and more fat-laden mesentry increasing towards the ileum.

86. TRUE statement regarding appendiceal neoplasms include which of the

following?

A. Carcinoid tumors of the tip of the appendix less than 1.5 cm are adequately treated
by simple appendectomy
B. Appendiceal carcinoma is associated with secondary tumors of the G1 tract in up
to 60% of patients
C. Survival following right colectomy for a Dukes' stage C appendiceal carcinoma is
markedly better than that for a similarly staged colon cancer at 5 years
D. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple
appendectomy, even in patients with rupture and mucinous ascites
E. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with
the liver as the most common site of spread

87.AII of the following statements about carcinoma of the gallbladder are correct
EXCEPT :

A. The neoplasm usually starts in the cystic duct and neck of the gallbladder.
B. It is found more commonly in women than men.
C. It is associated with the presence of gallstones in > 85% of cases.
D. Prognosis is generally poor with < 1 year survival with local invasion.
E. Chemotherapy and radiotherapy do not alter disease progression.

88. All of he following statements are true regarding diverticular disease EXCEPT:

A. It is found more commonly in the developed world.

B. Surgical treatment is usually unnecessary in acute uncomplicated cases.
C. Diverticulae are more commonly found in the descending colon.
D. Perforation and fistula formation can result from an attack of acute diverticulitis.
E. Resolution of the diverticulae can occur with high fiber diet and adcquate
hydration.

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

BY: HUSSEIN ALBAKKUSH / LIBYA-2018
BY: HUSSEIN ALBAKKUSH / LIBYA-2018
BY: HUSSEIN ALBAKKUSH / LIBYA-2018
BY: HUSSEIN ALBAKKUSH / LIBYA-2018
Final Part_Gen.Sug PII Oct.2018

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Q2---> E Rush 6th e p74 q5

Q3---> C Rush 6th e p76 q14

Q4---> B

Q5--->

Q6--->

Q7---> E?

Q8--->

Q9--->

Q10-->

Q11--> A

Q12--> B ASIR p321 q38

Q13--> B ASIR p106 q5

Q14--> B

Q15--> D

Q16-->

Q17--> E Lange 5th e p157 q2

Q18--> D ASIR p261 q51

Q19--> C ASIR p140 q2

Q20--> A ASIR p203 q1

Q21--> C ASIR p203 q2

Q22--> B Lange p260 q1

Q23--> A Lange p260 q2

Q24--> B ASIR p264 q59

Q25--> C ASIR p150 q30

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Part_Gen.Sug PII Oct.2018

Q26--> D,E? ASIR p146 q20

Q27--> A ASIR p4 q2

Q28--> D ASIR p16 q8

Q29--> A ASIR p9 q20

Q30--> A Lange p263 q11

Q31--> C? ASIR p169 q40 (modified)

Q32--> B ASIR p316 q23

Q33--> C ASIR p20 q52

Q34-->

Q35--> C MCQs in intensive care medicine p1 qA1

Q36--> E

Q37--> C ASIR p406 q102

Q38-->

Q39-->

Q40-->

Q41--> B

Q42-->

Q43--> D Single Best Answers in SURGERY 2nd e p43 q12

Q44-->

Q45-->

Q46-->

Q47--> C Rush 6th e p96 q34

Q48--> C

Q49-->

Q50--> A

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Part_Gen.Sug PII Oct.2018

Q51--> B

Q52-->

Q53-->

Q54-->

Q55-->

Q56-->

Q57-->

Q58-->

Q59-->

Q60-->

Q61--> B

Q62-->

Q63--> E KEY QUESTIONS IN SURGICAL CRITICAL CARE p32 q49

Q64--> B Schwartz ABSITE 9th e p101 q2

Q65--> C

Q66--> C MCQs in plastic surgery p11 q34

Q67--> D SESAP13 categ.6 q1

Q68--> B SESAP13 categ.6 q4

Q69--> B SESAP13 categ.6 q5

Q70--> D SESAP13 categ.6 q14

Q71--> E SESAP13 categ.6 q20

Q72--> E SESAP13 categ.6 q22

Q73-->

Q74-->

Q75--> A Rush 6th e p412 q33

BY: HUSSEIN ALBAKKUSH / LIBYA-2018

Final Part_Gen.Sug PII Oct.2018

Q76-->

Q77-->

Q78-->

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Q80-->

Q81--> D SESAP13 categ.3 q31

Q82-->

Q83--> D SESAP13 categ.8 q33

Q84-->

Q85--> D? Intercollegiate MRCS: Single Best Answer Practice Papers p102 q82

Q86--> A ASIR p156 q51

Q87--> A MRCS Irfan Halim p207 q31

Q88-->

Q89-->

Q90-->

Q91-->

Q92--> D Pretest 9th e q292

Q93--> D Pretest 9th e q300

Q94--> A Lange 5th e p191q15

Q95--> D Pretest 9th e q25

Q96-->

Q97--> A Surgery Review q83

Q98--> E Surgery Review q87

Q99--> D ASIR p322 q42

Q100->

BY: HUSSEIN ALBAKKUSH / LIBYA-2018